Your Path To Faster Answers

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1 Copyright c 2011 DIAGNOSTIC SYSTEMS OF GEORGIA, LLC Your Path To Faster Answers All Patients: See inside for a possible $50 credit on your bill and a token of our appreciation!

2 Welcome! We will see you This Patient Guide will help keep you on the path to understanding more about your radiology test. It includes helpful information regarding what to do before your test, getting results to your doctor, and making sure you get the best care quickly and in the most cost effective way. So, stick with us and we ll get you there! Referring practice:

3 WHY COME TO US FIRST? TO GET ANSWERS FASTER! Our goal is to provide your doctor with the fastest results so that together, you can decide if you need to see a specialist. Before you are sent to a specialist, seeing us first at Athens Diagnostic Center will make your following appointments more productive. Then you and your primary doctor or specialist can decide the best treatment path. And remember, you have a choice in where you go for your radiology needs. Tell your doctor you choose Athens Diagnostic Center. 2

4 OCONEE PRINTING, INC. (706) Contrast As Needed Per Radiologist Discretion (specify area) FOR MRI & CT CONTRAST PATIENTS: Does the patient have kidney disease, have diabetes or over the age of 70? yes no If yes to any of these, we will need a current BUN and creatinine level (within the last 3 months). TM Print Physicianʼs/PAʼs Name RFR# ADC - rev OCONEE PRINTING, INC. (706) TM BHF# ADC - rev08-10 Your doctor s office might give you a form that looks like this or an order written on a prescription pad. Be sure to bring it with you to your appointment Baxter Street - Athens, Georgia Tel: Toll Free: Fax: Appointment Date / / Appointment : Time WE UNDERSTAND... AND WE CAN HELP! *Self pay prices as low as $49 for xrays and $149 for mammograms *Payment plans for as low as $33 per month Forms available online for patients to fill out: A.M. P. M. Patient Name Insuredʼs Social Security # Patientʼs DOB Patient Phone Exam History/Diagnosis: Patientʼs Follow-Up Physician Appointment Date / / x x x PHYSICIANʼS SIGNATURE CPT MRI CPT CT CPT RADIOLOGY MRI Brain (without contrast) CT Head (without contrast) Chest PA / Lat MRI Brain (with/without contrast) CT Head (with/without contrast) Chest PA only MRI Pituitary CT Face, Orbit KUB MRI IAC CT (IACs, Mastoids) Abdomen (flat and erect) MRA Head (w/recon 76376) CT Sinuses Cervical Spine AP LAT (2 view) MRA Neck (w/recon 76376) CT Sinuses (LTD) Cervical Spine 5 view Appointment Date / / Appointment : Time 1063 Baxter Street - Athens, Georgia Tel: Toll Free: Fax: A.M. P. M. MAMMOGRAPHY FORM MRI Face (with/without contrast) MRI Orbits (with/without contrast) CT Neck (with contrast) CT Chest / Thorax (w/ contrast) (w/recon 76376) Cervical with Flex / Exten (7 view) Cervical Spine Flex / Exten only (2 view) Patient Name Insuredʼs Social Security # Patientʼs DOB Patient Phone MRI Neck (soft tissue) (with/without contrast) CT Chest w/o (f/u nodule) Thoracic Spine AP / Lat (2 view) MRI TMJ CTA Chest - PE protocol (w/recon 76376) Lumbar Spine AP / Lat (2 view) MRI Chest CT Cervical Spine (w/recon 76376) Lumbar Spine 5 view MRI Brachial Plexus Rt Lt CT Thoracic Spine (w/recon 76376) Lumbar Spine w Flex / Exten (7 view) MRI Cervical (without contrast) MRI Cervical (with/without contrast) CT Lumbar Spine (w/recon 76376) CT Abd/Pelv w/contrast (w/recon 76376) Lumbar Spine Flex-Exten only (2 view) S-I Joints Print Physicianʼs/PAʼs Name PHYSICIANʼS SIGNATURE MRI Thoracic (without contrast) CT Abd/Pelv w/o contrast Scoliosis Survey MRI Thoracic (with/without contrast) MRI Lumbar (without contrast) MRI Lumbar (with/without contrast) MRI Abdomen (specify organ) MRA Abdomen (w/recon 76376) MRI Pelvis (soft tissue or boney) MRI Upper Extremity Rt or Lt MRI Arthrogram (check exam below) MRI Shoulder Rt or Lt MRI Elbow Rt or Lt MRI Wrist Rt or Lt MRI Lower Extremity Rt or Lt (Stone Protocol) (w/recon 76376) CT Abd w/contrast (w/recon 76376) CT Pelvis w/contrast (w/recon 76376) CT Abd w & w/o contrast (w/recon 76376) Specify organ: CT Upper Extrm (w/recon 76376) Rt Lt CT Lower Extrm (w/recon 76376) Rt Lt CTA Head (w/recon 76376) CTA Abd (w/recon 76376) Other: CPT ULTRASOUND U / S Abdomen Heel / Os Calsis Foot Rt Lt Toes RT Lt Ankle Rt Lt Tibia-fibula Rt Lt Knee Rt Lt Femur Rt Lt Pelvis Shoulder Rt Lt Clavicle Rt Lt Humerus Rt Lt Elbow Rt Lt Forearm Rt Lt X CPT SCREENING MAMMOGRAM (ASYMPTOMATIC) G0202 Unilateral V76.12 Right Left (w/cad ) G0202 Bilateral V76.12 (w/cad ) Screening Mammograms: Asymptomatic - including screening for high-risk patients with no symptoms. Diagnosis for these are: Routine No symptoms Fibrocystic breast disease (asymptomatic) Family history of breast cancer X CPT Breast Ultrasound - unilateral - Right Left Breast Ultrasound - bilateral DIAGNOSIS: BREAST ULTRASOUND Palpable breast mass or lump Abnormal mammogram (unspecified) Mammographic calcifications Other abnormality on radiographic examination of breast Other ICD-9 code DIAGNOSTIC FORM MRI Knee Rt or Lt MRI Hind Foot / Ankle / Rt or Lt MRI Fore Foot / Rt or Lt MRI Hip / Rt or Lt MRI Sacrum / Coccyx Other: OPEN MRI (specify appropriate exam above) U / S Gallbladder U / S Aorta U / S Hepatic Veins U / S Renal U / S Pelvis U / S Transvaginal U / S Obstetrical trimester U / S Testicular U / S Thyroid U / S Carotids (bioscan) U / S Venous flow (leg) Bilateral U / S Venous flow (leg) Rt Lt CPT BONE DENSITY Bone Density Wrist Rt Lt Hand Rt Lt Fingers Rt Lt Skull Ap & Lat Sinuses Orbits Bone Age Ribs - bilateral Hip Rt Lt Sacrum / Coccyx Other: SCREENINGS Cardiac Scoring S.A.V.E. Screenings (carotids, aorta, ABI) CPT MAMMOGRAPHY G0202 Digital Mammogram Screening X CPT DIAGNOSTIC MAMMOGRAM (SYMPTOMATIC) To include special views and/or ultrasound if indicated. G0206 Unilateral Right Left (w/cad ) G0204 Bilateral (w/cad ) DIAGNOSIS: Breast cancer - still under current treatment Palpable breast mass or lump (to include ultrasound if indicated by radiologist) Abnormal mammogram (unspecified) Mammographic calcifications Metastasis (unkown primary) v10.3 Personal history of breast cancer 610. Fibrocystic breast disease (symptomatic) Painful or tender breast (acute onset) Skin/nipple changes, nipple discharge Other abnormality on radiographic exam of breast 6 month follow-up after benign biopsy X CPT PROCEDURES 76942/19000 Fine Needle Cyst Ultrasound - guided Aspiration Right Left Bilateral 76942/19102 Ultrasound - guided Core Biopsy Right Left Bilateral 77053/19030 Ductogram/Galactogram Right Left Bilateral ADDITIONAL CLINICAL HISTORY INFORMATION: Accredited by the American College of Radiology Other ICD-9 code PLEASE MARK AREA OF CONCERN FOR ALL PALPABLE LUMPS RIGHT LEFT 3

5 If you ve had TESTS done at OTHER PLACES BEFORE, IT S NOT A PROBLEM... With your permission, we can get your previous test results from other offices (facilities). We use the Internet to send the results of your test back to your doctor quickly. Heck, even if you move to Alaska - we can get your results to your doctor there! We maintain a permanent lifetime record of your test that is available to any doctor, anywhere, and at anytime (with your permission). We re glad you chose us! Now, here we go... 4

6 HEAD (BRAIN) NECK (CERVICAL SPINE) HAND WRIST ELBOW CHEST (THORAX) BELLY (ABDOMEN) HIP MIDDLE BACK (THORACIC SPINE) LOWER BACK (LUMBAR SPINE) KNEE LEG FOOT 5 ANKLE

7 A FEW THINGS YOU LL WANT TO KNOW... If you re having an MRI, you ll hear some loud thumping sounds during the test. This is normal and it s just the way the equipment works - don t be alarmed. We have earplugs available if you need them. If you d like to have a family member (that is safe to go into the MRI room) in the room with you, that s fine, too. Also, if you have a pacemaker or aneurysm clip, please tell your doctor because you CANNOT have an MRI. If you are unsure about an implant you can ask us if it is safe. we are an acr accredited facility If you need any pre-test blood work, we can do this at your appointment (sometimes you ll need this before having CT or MRI dye (contrast)). Picture (imaging) quality is better on a high-field magnet, but we know some people have anxiety about going inside what they see as a tunnel. Our experienced technologists take a lot of time to make sure you re comfortable about going into the MRI, but if it bothers you too much, we have an open MRI, too. For each part of your body, we have a radiologist that specializes in that area. For example, our brain tests are read by a fellowship-trained, board certified, neuro-radiologist (this means they are the best of the best!). If you have any other questions, concerns or need to reschedule your appointment call us at (706)

8 BEFORE YOUR TEST... You ll be contacted by one of our staff the day before your appointment to go over any preparation necessary for your test. For some of our tests, you may be asked to drink a tasteless liquid (we call it contrast ) before your test. (This replaces the old fashioned chalky drink that most places use.) You may also be asked not to eat or drink anything several hours prior to having the test done. If your doctor says it s necessary, you may be given an IV with contrast fluid. But don t worry - we ll explain everything! Our medical professionals will need to know some information prior to your test: Medical history Allergies Presence of metal in your body Surgical history 7 PLEASE FOLLOW YOUR INSTRUCTIONS CAREFULLY SO THAT YOU GET THE BEST RESULT POSSIBLE... STAY ON THE PATH!

9 NEXT STEP ALONG THE PATH... AT YOUR APPOINTMENT When you arrive at our center, our friendly staff will make you feel welcome. You can park near the front door with just a short walk to the reception counter. And parking is even FREE!! You ll need to fill out some paperwork (yep, sorry but we don t make these rules!). We are not permitted to give you any information at the time of your test - this information must come from your doctor. We ll address any concerns you may have before starting your test. AND AFTER YOUR APPOINTMENT Your doctor will get a report from our radiologist in time for your follow up visit at his/her office. They ll go over the test report with you and decide the next step in your care. Your doctor can also look at the pictures (images) we ve taken and the test report on the computer at his/her office. PSSSSSST... Want to know more? Follow Me! 8

10 9 WANT TO KNOW OUR SECRET? WE RE TELLING YOU SOMETHING NO ONE ELSE IS WILLING TO REVEAL...

11 44%-59% savings! independent outpatient imaging centers vs. hospitals and SPECIALISTS OFFICE average mri fees paid to providers $1,000 $800 $600 $832 $646 $461 $400 $200 Hospital Specialists Office SOURCE: Radiology Business Journal, April/May 2011, Vol. 4 Fees based on technical charges only. Professional fees additional. Based on average insurance payments. WE VE PULLED BACK THE CURTAIN ON PRICES FOR radiology TESTS! 10

12 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ CAUTION! DETOURS AHEAD... MEDICAL BILLING IS CONFUSING... LET US KEEP YOU ON THE RIGHT PATH! Whether you have insurance, Medicare or are Self Pay, we save you money! Athens Diagnostic Center gets paid less by your insurance company than either hospitals or physicians offices. Think about the 20% or 30% you ll owe after insurance pays (your co-insurance)... if we get paid less, your 20% or 30% is less! SAME TESTS AT LOWER PRICES... WHY WOULD YOU PAY MORE? If you have Medicare... Even if you have Medicare, we can save you money. For example, you ll save $15 or more on an MRI of your brain. You may think Medicare pays all providers the same but they don t! 11

13 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ IF YOU HAVE INSURANCE... Remember your deductible? - It s YOUR money being spent first, before your insurance company pays. So make sure you spend it wisely! Less than 10% of people meet their yearly deductible. So, if you re really spending your own money (under the deductible) why not get the best value? And keep in mind... you get ONE easy to understand bill from us that includes everything instead of TWO bills - one from the hospital and another from the radiologist. Plus, we also offer affordable payment plans to fit any budget as low as $33 per month. WHY would you pay more? Tell your doctor to choose Athens Diagnostic Center! 12

14 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ AND IF YOU DON T HAVE INSURANCE... For uninsured/self pay patients... we guarantee you the lowest price in town! Before your test, we welcome you to call around and check prices. If you do, make sure you ask for the global fee (that s the cost of the exam AND the doctor s reading fee). Here are some examples... (if you pay in full at THE time of your test) X-RAY... AS LOW AS $49 DIGITAL MAMMOGRAPHY...$149 MRI... AS LOW AS $550 ULTRASOUND... AS LOW AS $200 The savings are clear! CT SCAN... AS LOW AS $200 13

15 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ STAY ON THE FAST PATH... MORE REASONS TO COME TO US FIRST! If your specialist has your diagnostic test results at your first appointment, he or she can recommend the best treatment options for you. This makes it a more informative visit. This saves you money by combining two office visits into one (saving you a co-pay). 14

16 GO TO OUR WEBSITE FOR MORE INFORMATION: Print your forms online - save time at check in Learn more about the tests we offer and how to prepare Directions to our center Virtual picture tour of Athens Diagnostic Center Read what others are saying about our services Give feedback on our services We re here for you! Call or us today with any questions! (706)

17 MRI PATIENTS $50 credit on your bill When you come to Athens Diagnostic Center FIRST, it enables us to reduce our costs per patient; as a result, we can pass some of the savings along to you. For all other tests... a small token of our appreciation Credit applies to your portion of the bill (after your insurance company pays) any credit balance will be applied to future tests. Does NOT apply to government patients, e.g., Medicare,Medicaid, TriCare, Champus or any government funded insurance program whether primary, secondary or tertiary. Credit is a one-time, lifetime credit. Must present coupon at time of service for credit. WHILE SUPPLIES LAST Offer expires: 12/31/2012 Thank You for choosing athens diagnostic center

18 YOUR HEALTH + YOUR MONEY YOUR = CHOICE 17

19 THANK YOU FOR CHOOSING Athens Diagnostic Center Free parking and Jittery Joes coffee make you feel right at home!

20 Milledge Avenue Hawthorne Avenue Broad Street Magnolia Street Kroger Hospital Baxter Street Alps Road Public Library MRI CT Open MRI X-Ray Bone Density Digital Mammography Ultrasound 1063 Baxter Street - Athens, Georgia (706) Copyright c 2011 DIAGNOSTIC SYSTEMS OF GEORGIA we are an acr accredited facility

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